Matthew T. Reynolds, PA-C, shares his treatment approach to plaque psoriasis based on the expanding therapeutic landscape.
Jayme Heim, MSN, FNP-BC: Could you talk about the implications of the current expansion of the therapeutic landscape? Over the last years, especially the last 15 years, it’s evolved quite a bit. There are medications available for treatment of plaque psoriasis that continue to evolve. We also have a problem identifying which of those medications to use sometimes with the patients with plaque psoriasis. Can you tell me more about your treatment approach for patients with plaque psoriasis?
Matthew T. Reynolds, PA-C: Absolutely. I believe wholeheartedly that this truly is the golden age of psoriasis treatment. We’ve come a long way in our options, in our armamentarium, with treating patients. I truly feel like we have a toolbox where we can walk into any patient at any time and have a variety of options to not only pick for the patient, but to have them help guide treatment decisions. We now have treatment options for children and adults that provide outstanding skin clearance rates and improve overall quality of life for our patients. With the expansion of the IL-17 [interleukin-17] and IL-23 [interleukin-23] classes, we now have a multitude of drugs to treat our patients to complete clearance, whereas a long time ago, we didn’t have that as an option. PASI [psoriasis area and severity index] 75, PASI 50 were really good response rates not just a decade ago. The significance in these new treatments is that we can confidently assume that most of our patients are going to be at least 90% better in their skin score rates of their psoriasis and across both classes of drugs, the IL-17 and IL-23 classes. Secondly, these drugs are becoming easier to prescribe due to a lack of overall adverse events and insurance access. Upper respiratory tract infections, tinea infections, MACE [major adverse cardiovascular] events, malignancies, inflammatory bowel disease rates are very, very low across both classes of drugs. Lastly, with the widespread awareness of these medications and their rapid expansion into the dermatology space, more and more prescribers are now using them, which is great for patients and then great for the overall health care system. We now know that biologic prescription rates are increasing faster than they ever have in previous years, and these biologic agents are being written more and more by advanced practice providers like nurse practitioners and physician assistants. Now, certainly every APP doesn’t only see plaque psoriasis patients. We see many types of general dermatology patients. But often the APP is now assuming that role of identifying appropriate plaque psoriasis patients for biologic therapy and managing their disease.
Jayme Heim, MSN, FNP-BC: Thank you, Matt. In your opinion, if as an APP you’re working in an academic setting or a private practice setting, or even a community-type setting, what would be the differences within practice in dermatology?
Matthew T. Reynolds, PA-C: I meet a lot of people from around the country who practice in 1 or both settings. I think the differences between these 2 settings specifically are fairly stark. I know in my area in central Arkansas that the academic center has very restricted rules on allowing pharmaceutical industry access to the dermatology center or to the residents or the PAs [physician assistants], PNs [practical nurses] or students. Therefore, education and access to vital information for writing prescriptions may favor older therapies for patients with more insurance or no insurance as a way of saving costs in the academic setting. In the community setting, we would most likely provide those patients with newer therapies or samples or access to, say, a clinical trial. Those are becoming more and more popular in private setting. An academic setting is also more likely to use infusible products due to the access and proximity to [an] infusion center. There are drugs that are specifically infused in psoriasis or provided better in an infusion-type setting. A patient would most likely receive, for instance, adalimumab in a community setting, whereas at an academic setting they may receive certolizumab so that the academic center may capture additional reimbursement for that medication. The same is true of the IL-23 class and tildrakizumab. Now as an APP, there’s an extreme sense of flexibility in working in the community setting that we seemingly have more access to our pharmaceutical reps, our sales reps, our MSLs [medical science liaison], more access to samples, and a little bit more prescription authority versus, say, an academic setting with harsher rules on access to drugs, access to filling out prior authorizations for drugs, and things of that nature.
Transcript edited for clarity